DOCSLIB.ORG

Hepatic Sarcoidosis

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Hepatic Sarcoidosis Review Article Hepatic Sarcoidosis Micheal Tadros1, Faripour Forouhar2 and George Y. Wu1 1Department of Medicine, Division of Gastroenterology-Hepatology, University of Connecticut Health Center, Farmington, CT, USA; 2Department of Anatomic Pathology, University of Connecticut Health Center, Farmington, CT, USA Abstract ethnicities,6 with an age peak of 20–40 years.6 A second age peak (.50 years) has also been described.6 Sarcoidosis is a multisystem disease characterized by the The hallmark of sarcoidosis is the formation of epithelioid presence of non-caseating granulomas in affected organs. granulomas that are typically non-caseating, in the absence Pulmonary involvement is the most common site of disease of tuberculosis, fungal infection, malignancy, or other causes activity. However, hepatic involvement is also common in of granulomatous reactions.7 The pulmonary system is the sarcoidosis, occurring in up to 70% of patients. Most patients most common site of involvement, and is affected in about with liver involvement are asymptomatic. Therefore, the 90% of cases.6 Extra-thoracic sarcoidosis occurs in 40–50% majority of cases are discovered incidentally, frequently by of patients.8 Sites affected include peripheral lymph nodes the finding of elevated liver enzymes. Pain in the right upper (30%), the hepatic system, the spleen, stomach, small quadrant of the abdomen, fatigue, pruritus, and jaundice may bowel, bone, and skin. Involvement of the solid organs can be associated with liver involvement. Portal hypertension and present as organ enlargement. Dermatological sarcoidosis cirrhosis are complications linked to long-standing hepatic may present as erythema nodosum or lupus pernio. sarcoidosis. Liver biopsy is usually required to confirm the Myopathy, uveitis, granulomatous meningitis, facial nerve diagnosis. It is important to differentiate hepatic sarcoidosis palsy, cardiomyopathy, and parotid enlargement have been from other autoimmune and granulomatous liver diseases. reported less commonly. Not all cases of hepatic sarcoidosis require treatment. For There are two classic syndromes described for sarcoidosis. symptomatic patients, the first line treatment includes The first is Lo¨fgren syndrome, which is characterized by hilar corticosteroids or ursodeoxycholic acid. Various immunosup- lymphadenopathy, erythema nodosum, arthritis and fever.6 pressant agents can be used as second line agents. Rarely, The second is Heerfordton syndrome, which is characterized severe cases require liver transplantation. by uveitis, swelling of the parotid gland, fever, and facial E 2013 The Second Affiliated Hospital of Chongqing Medical palsy.9 University. Published by XIA & HE Publishing Ltd. All rights The pathogenesis of sarcoidosis is still not completely reserved. understood, but it is thought to be multifactorial, involving the interplay of immunological, genetic, and environmental Introduction factors.1,6 It has been theorized that an environmental trigger initiates a specific immune reaction in a genetically Sarcoidosis is an inflammatory disorder of unknown etiology predisposed individual. The immunological response in sar- categorized by the presence of non-caseating granulomas, coidosis includes T helper 1 (Th1) cells triggered by an which can involve multiple organs of the body,1 in the antigen, leading to cytokine production, mainly tumor absence of infections, other autoimmune diseases, and necrosis factor alpha10 which in turn, leads to macrophage exposure to foreign agents. It has been estimated that the aggregation with subsequent granuloma formation.11 Certain worldwide prevalence of sarcoidosis is 2–60 per 100,000 histocompatibility antigens have been associated with sar- people.2 Sarcoidosis affects all ethnicities with higher pre- coidosis such as human leukocyte antigen-A1 (HLA-A1), B8, valence rates described in patients of Scandinavian descent.2 DRB1, DQB1, and DRB3.12 This suggests a genetic suscept- In contrast, sarcoidosis has been only rarely reported in ibility and familial clustering of the disease. Some of the patients of Chinese and Taiwanese origin.3,4 In the USA, possible postulated triggers of environmental antigens African Americans have been reported to have a three times include reactive oxygen species, and viruses (herpes simplex higher age-adjusted incidence of the disease.1,5 Sarcoidosis virus, cytomegalovirus, retroviruses) and bacteria (Borrelia affects females more often than males across all ages and burgdorferi, mycobacteria).2,6 Keywords: Sarcoid; Granuloma; Epitheloid. Epidemiology of hepatic sarcoidosis Abbreviations: ACE, serum angiotensin converting enzyme; AFB, acid-fast bacteria; AMA, anti-mitochondrial antibody; ERCP, endoscopic retrograde cho- In biopsy and autopsy studies of patients with systemic langiopancreatography; MRCP, magnetic resonance cholangiopancreatography; sarcoidosis, liver involvement was found in about 50–80%,17 MRI, magnetic resonance imaging; p-ANCA, peripheral anti-neutrophil cytoplas- mic antibody; PBC, primary biliary cirrhosis; PSC, primary sclerosing cholangitis. whereas only 10–30% of patients presented with abnormal 2,18 Received: 21 September 2013; Revised: 9 October 2013; Accepted: 9 October liver enzymes during laboratory testing. The majority of 2013 q patients with hepatic sarcoidosis are asymptomatic, despite DOI of original article: 10.14218/JCTH.2013.00016. the presence of granulomas on biopsy, abnormal liver Correspondence to: George Y. Wu, Department of Medicine, Division of 14 Gastroenterology-Hepatology, University of Connecticut Health Center, enzymes, or radiological evidence of disease. It has been Farmington, CT 06030, USA. E-mail: [email protected] reported that the percentage of patients with clinically Journal of Clinical and Translational Hepatology 2013 vol. 1 | 87–93 Tadros M. et al: Sarcoid of the liver significant disease is less than 20%.19 Risk factors associated transplantation cases in the USA. Unfortunately, they often with hepatic sarcoidosis include African American ethnicity, have a worse prognosis than patients with other cholestastic prior exposure to pegylated interferon, and the presence of liver diseases such as primary biliary cirrhosis and primary splenomegaly.13,14,20 Reports on the differences in preva- sclerosingcholangitis.29 Some case reports have linked sar- lence based on gender have been contradictory. In studies coidosis with an increased risk of developing Budd-Chiari30 containing hundreds of patients, one study reported liver syndrome, hepatopulmonary syndrome,28 hepatocellular disease to be more common in women,21 whereas the other carcinoma,31,32 and biliary sarcoid mimicking cholangiocarci- showed the opposite.22 noma. Table 1 lists postulated mechanisms of liver injury in hepatic sarcoidosis. Table 2 summarizes the clinical spectrum Spectrum of hepatic sarcoidosis of the disease. There is a spectrum of clinical presentations of liver involve- Investigations ment in sarcoidosis. Of the more than 50% of patients who have hepatic granulomas on liver biopsy, only 10–30% have Elevations of alkaline phosphatase and/or gamma glutamyl- elevated serum liver enzymes.2,18 About 20% of patients transpeptidase have been correlated with cholestasis and have palpable hepatomegaly or splenomegaly. Radiological liver involvement.25,34 Alkaline phosphatase of hepatobiliary examination (ultrasound or computed tomography) is accu- origin can be elevated 5–10 times the upper limit of normal. rate in the detection of organomegaly, demonstrating this Aminotransferase elevations are usually mild and less fre- feature in about 40% of cases.13,17 However, even in cases of quent compared with elevations in alkaline phosphatase.19 elevated serum liver enzymes or radiological abnormalities, The severity of liver test abnormalities was shown to be evidence of organ dysfunction is rare. associated with the extent of granulomatous inflammation.33 Some clinical symptoms and signs suggest liver involve- Hyperglobulinema may be seen. Measurement of the serum ment, and may warrant a liver biopsy. Systemic symptoms angiotensin converting enzyme (ACE) levels can be useful; such as fatigue, fever, and arthralgias are non-specific, but they have been reported to be elevated in about 60% of are present in the majority of patients with active liver patients with active sarcoidosis.35–37 However, the test lacks sarcoidosis.23,24 More specific symptoms include jaundice sensitivity and specificity, with low positive and negative and pruritus, mostly from chronic cholestasis.25,26 Right predictive values (84 and 74%, respectively).38 Normal levels upper quadrant abdominal pain, in theory, results from can be seen in chronic forms and in patients who have been stretching of the Glisson’s capsule by hepatomegaly as a on corticosteroids. Therefore, a normal ACE level does not consequence of the increasing intrahepatic volume occupied rule out sarcoidosis, but an elevated level may help distin- by the developing hepatic granulomas. Abdominal pain has guish sarcoidosis from other granulomatous disease. been reported to occur in 15% of patients with sarcoidosis, Elevated ACE levels can also be present in patients with and jaundice in less than 5%.19 inflammatory bowel disease.36 Long-standing disease has been reported to result in Radiological studies39 such as ultrasonography,40 com- portal hypertension in 3–18% of patients.16 This may be due puted tomography (CT)41 or magnetic resonance imaging initially to compression of portal venules by granulomas,
Load more

Recommended publications
  • Heerfordt's Syndrome, Or Uveoparotid Fever
    T h e new england journal o f medicine images in clinical medicine Lindsey R. Baden, M.D., Editor Heerfordt’s Syndrome, or Uveoparotid Fever A B C D Anisha Dua, M.D. 32-year-old woman presented with a 6-week history of swelling of both parotid glands, dry eyes, and dry mouth. She reported having difficulty West Penn Allegheny Health System Pittsburgh, PA A moving the right side of her face, and she felt tingling in the right side of her tongue. Physical examination revealed enlargement of both parotid glands, which were Augustine Manadan, M.D. firm and nontender, submandibular enlargement, and enlargement of lacrimal glands (Panel A). She did not have a fever, and there was no uveitis. She could not completely Rush University Medical Center Chicago, IL close her right eye, was unable to purse her lips, and was unable to smile on the right side of her face. Facial sensation was symmetric and intact. The results of a test for Lyme disease and the human immunodeficiency virus were negative. Serum IgG4 levels were normal. A chest radiograph suggested bilateral hilar adenopathy and possible right para tracheal adenopathy but was otherwise unremarkable. Computed tomography of the head revealed enlargement and increased uniform contrast enhancement of the both parotid glands (Panel B). A biopsy specimen from the right parotid gland revealed scattered granulomas with focal central necrosis. Stains for acid-fast bacilli and fungi were negative (Panel C, hematoxylin and eosin). She was given a diagnosis of Heer- fordt’s syndrome, a rare form of sarcoidosis in which the compression of the facial nerve results in palsy.
    [Show full text]
  • Facial Nerve Disorders Cn7 (1)
    FACIAL NERVE DISORDERS CN7 (1) Facial Nerve Disorders Last updated: January 18, 2020 FACIAL PALSY .......................................................................................................................................... 1 ETIOLOGY .............................................................................................................................................. 1 GUIDE TO LESION SITE LOCALIZATION ................................................................................................... 2 CLINICAL GRADING OF SEVERITY .......................................................................................................... 2 House-Brackmann grading scale ........................................................................................... 2 CLINICO-ANATOMICAL SYNDROMES ..................................................................................................... 2 Supranuclear (Central) Palsy ................................................................................................. 2 Nuclear Lesion ...................................................................................................................... 3 Cerebellopontine Angle Syndrome ....................................................................................... 3 Facial Canal Syndrome ......................................................................................................... 3 Stylomastoid Foramen Syndrome ........................................................................................
    [Show full text]
  • Lyme Disease Diagnostic Support Tool
    1 / 11 For further details, click on the DIAGNOSTIC SUPPORT TOOL underlined words. Localized and disseminated stages of Lyme disease This diagnostic support tool is intended mainly for primary care clinicians. It is provided for information purposes only and should not replace the judgement of the clinician who performs the activities reserved under a statute or regulation. The recommendations in this tool were developed using a systematic process and are supported by the scientific literature and the knowledge and experience of Québec health professionals, experts and patients. For further details, go to the “Publications” section of INESSS’s website inesss.qc.ca. This tool does not deal with other tick-borne infections or with the much-debated form of Lyme disease, which is sometimes referred to as the chronic form. WHAT IS LYME DISEASE ? WHAT ARE THE DIFFERENT STAGES OF THE DISEASE? GENERAL INFORMATION • Lyme disease is an infectious disease caused by bacterial Localized stage (sometimes called the early stage): Beginning Patient with a tick genospecies of Borrelia burgdorferi, which are transmitted of the infection before dissemination of the bacteria in the • If tick is attached, refer to the procedure for removing it. to humans by black-legged ticks that are carriers. bloodstream. • Refer to the tick surveillance procedure. • Main manifestation observed: • It is a notifiable disease (MADO) • Consult the decision support tool or the Québec’s national and is on the increase in Québec. Not always present or noticed. medical protocol on post-exposure prophylaxis. • It can affect several anatomical systems at the same time. If present, usually appears • Identifying the tick and obtaining proof that it carries of Lym 3 to 30 days after infection or e d B.
    [Show full text]
  • Heerfordt-Waldenstrom Syndrome Uveoparotid Fever
    Case Report Heerfordt-Waldenstrom Syndrome Pak Armed Forces Med J 2015; 65(5): 716-17 HEERFORDT-WALDENSTROM SYNDROME UVEOPAROTID FEVER: REVIEW OF THE LITERATURE AND A CASE PRESENTATION Kamil Shujaat, Aysha Babar*, Maryam Rashid**, Syed Saif Ur Rehman, Shujaat Hussain Al-Nafees Medical College Islamabad Pakistan, *Yusra Medical and Dental College Islamabad Pakistan, **Akhtar Saeed Medical and Dental College Lahore Pakistan ABSTRACT Heerfordt-Waldenström syndrome is also referred to as uveoparotid fever. In our patient physical examination showed bilateral parotid gland enlargement. Chest X-ray showed bilateral hilar lymph adenopathy. Biopsy specimen from the right parotid gland revealed scattered granulomas with focal central necrosis. Stains for acid-fast bacilli and fungi were negative. He was diagnosed as a case of Heerfordt- Waldenström syndrome, a rare form of sarcoidosis in which the compression of the facial nerve results in palsy. He was treated with 60 mg of prednisone daily, and at follow-up after two weeks later, the swelling and uveitis was resolved. Keywords: Heerfordt-waldenstrom syndrome, Uveoparotid fever. INTRODUCTION calcium was 9.7 mg /dl. X-ray chest (PA) view showed bilateral hilar lymphadenopathy (fig-2). Heerfordt syndrome also called as Fine needle aspiration of parotid gland revealed uveoparotid fever is a rare type of sarcoidosis which presents with fever, uveitis, parotid gland enlarement and cranial nerve palsies most commonly facial nerve1. In 1909, the condition was first described by Danish ophthalmologist Christian Frederick Heerfordt, for whom the syndrome is now named2. CASE REPORT We report a case of 24 years old student who presented with 2 weeks history of fever, cough, and facial palsy, difficulty in swallowing and blurred vision (fig-1).
    [Show full text]
  • Sarcoidosis (Heerfordt Syndrome): a Case Report Tiia Tamme, Edvitar Leibur, Andres Kulla
    REVIEW Stomatologija, Baltic Dental and Maxillofacial Journal, 9:61-64, 2007 Sarcoidosis (Heerfordt syndrome): A case report Tiia Tamme, Edvitar Leibur, Andres Kulla SUMMARY We report the case of a 22-year-old woman who is suspected of having primary Sjögren´s syndrome. She complaining of bilateral swelling of eyelids and the parotid glands of three weeks duration. Physical examination revealed a bilateral enlargement of both parotid glands, which were solid and painful. Sjögren´s syndrome was suspected at that stage, and the serologic and specific analysis were done. All these tests didn´t find any autoimmune or visceral features typical of Sjögren´s syndrome and autoantibodies were negative. During follow-up time the right facial nerve palsy de- veloped. Pulmonary radiography revealed bihilar lymphadenopathy and labial salivary gland biopsy revealed non-caseating granuloma. The patient was classified as having stage I sarcoidosis. This case demonstrates the importance of being aware of the leading clinical signs and symptoms in case of Heerfordt syndrome. Key words: Sjögren syndrome, sarcoidosis, Heerfordt syndrome. INTRODUCTION Sarcoidosis is a condition characterized by multiple appear to have the highest prevalence rates in the world nodular lesions in the skin, internal organs, eyes, sali- [7]. vary glands, and with enlargement of lymphnodes [1]. Geographic and environmental factors may explain Danish ophthalmologist C. F. Heerfordt first described differences between countries and age groups [8]. the symptom triad – uveitis, parotid gland enlargement An abnormal immune response to a yet unidenti- and cranial nerve paresis in 1909 [2]. Sarcoidosis rep- fied antigen is suspected as the cause. resents a granulomatous disease of obscure etiology.
    [Show full text]
  • Heerfordt-Waldenström Syndrome Manifesting As Cardiac Sarcoidosis
    Open Access Case Report DOI: 10.7759/cureus.10619 Heerfordt-Waldenström Syndrome Manifesting as Cardiac Sarcoidosis Sebastian Mikulic 1 , Pujan Patel 2 , Sandra Sheffield 1 , Fadi Kandah 1 , Gladys Velarde 2 1. Internal Medicine, University of Florida Health Jacksonville, Jacksonville, USA 2. Cardiology, University of Florida Health Jacksonville, Jacksonville, USA Corresponding author: Sebastian Mikulic, [email protected] Abstract Sarcoidosis is a granulomatous disease histologically characterized by non-caseating granulomas. Although it usually affects the lungs, it can affect any organ system and present with a wide variety of symptoms. Heerfordt-Waldenström Syndrome, or uveoparotid fever, is a rare form of sarcoidosis that presents with a combination of fever, parotitis, facial paralysis, and uveitis. In this case report, we demonstrate a rare manifestation of sarcoidosis in a patient who presents with both the aforementioned syndrome and cardiac involvement. This case serves to highlight the importance of identifying the various clinical manifestations and management of systemic sarcoidosis. Categories: Cardiology, Internal Medicine, Rheumatology Keywords: heerfordt-waldenström syndrome, uveoparotid fever, sarcoidosis, cardiac sarcoidosis Introduction Sarcoidosis is a multi-organ inflammatory disease of unknown etiology. It is characterized by the deposition of non-caseating granulomas in various tissues, and patients are generally diagnosed early in adulthood, usually before the age of 50. The incidence and prevalence of sarcoidosis are highest in African Americans. The disease can affect multiple organ systems: musculoskeletal, respiratory, ocular, cardiovascular, gastrointestinal, lymphatic, and neurological systems [1]. Heerfordt-Waldenström syndrome is a rare presentation of sarcoidosis. First described by Dr. Christian Heerfordt in the early 1900s, and later connected to sarcoidosis by Dr.
    [Show full text]
  • Salivary Gland Pathology
    www.downstatesurgery.org Salivary Gland Pathology Eric Klein, M.D. SUNY Downstate Department of Surgery www.downstatesurgery.org Case 1 • 32 y/o male with episodic pain and swelling from his left upper neck for several years • Enlarged, non-tender left submandibular gland and surrounding lymphadenopathy • No palpable stones • CT scan - small calculi • FNA lymph nodes – benign, reactive www.downstatesurgery.org Case 1 • Left submandibular gland excision with biopsy of enlarged level 2 and 3 lymph nodes • Mild focal chronic sialoadenitis • Lymph nodes – reactive hyperplasia www.downstatesurgery.org Case 2 • 58 y/o female with progressively enlarging left facial mass for 40 years • 8 x 7 cm lobular mass overlying angle of jaw • No palpable lymphadenopathy • Facial nerve function intact • CT scan – 2.8 x 2.2 cm cystic mass in superficial left parotid gland www.downstatesurgery.org www.downstatesurgery.org www.downstatesurgery.org www.downstatesurgery.org www.downstatesurgery.org www.downstatesurgery.org Case 2 • Left superficial parotidectomy • 6 x 5 x 4 cm parotid gland with chronic sialadenitis • 3 cm lymphoepithelial cyst www.downstatesurgery.org Outline • Anatomy • Physiology • Non-neoplastic Diseases • Benign Tumors • Malignant Tumors www.downstatesurgery.org Anatomy • Parotid glands – Stenson duct -> opposite 2nd maxillary molar • Submandibular glands – Wharton duct -> behind mandibular incisors • Sublingual glands – Major duct of Bartholin -> Wharton duct – Multiple minor ducts of Rivinus -> floor of mouth • Minor Salivary glands www.downstatesurgery.org
    [Show full text]
  • Two Cases of Heerfordt's Syndrome: a Rare Manifestation of Sarcoidosis
    Hindawi Publishing Corporation Case Reports in Otolaryngology Volume 2016, Article ID 3642735, 4 pages http://dx.doi.org/10.1155/2016/3642735 Case Report Two Cases of Heerfordt’s Syndrome: A Rare Manifestation of Sarcoidosis Keishi Fujiwara,1 Yasushi Furuta,2 and Satoshi Fukuda1 1 Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Hokkaido University, N15W7, Kita-ku, Sapporo 0608638, Japan 2Department of Otolaryngology, Head and Neck Surgery, Teine-Keijinkai Hospital, 12-1-40 Maeda 1-Jo, Teine-Ku, Sapporo 0068555, Japan Correspondence should be addressed to Keishi Fujiwara; [email protected] Received 16 September 2015; Accepted 21 December 2015 Academic Editor: Abrao˜ Rapoport Copyright © 2016 Keishi Fujiwara et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Heerfordt’s syndrome is a rare manifestation of sarcoidosis characterized by the presence of facial nerve palsy, parotid gland enlargement, anterior uveitis, and low grade fever. Two cases of Heerfordt’s syndrome and a literature review are presented. Case 1. A 53-year-old man presented with swelling of his right eyelid, right facial nerve palsy, and swelling of his right parotid gland. A biopsy specimen from the swollen eyelid indicated sarcoidosis and he was diagnosed with incomplete Heerfordt’s syndrome based on the absence of uveitis. His symptoms were improved by corticosteroid therapy. Case 2. A 55-year-old woman presented with left facial nerve palsy, bilateral hearing loss, and swelling of her bilateral parotid glands.
    [Show full text]
  • Heerfordt's Syndrome
    Case Report Heerfordt’s syndrome: an uncommon manifestation of sarcoidosis Ahmed SMa, Hossain Aa, Azad MRb, Khan MSHc, Islam MRd ABSTRACT Heerfordt’s syndrome – the combination of facial palsy, parotid swelling, anterior uveitis and fever, is a rare manifestation of sarcoidosis. Here, we present case history of a patient with bilateral lower motor neuron facial nerve palsy, who was found to have bilateral parotid gland swelling and bilateral hilar lymphadenopathy. Computed tomography guided fine needle aspiration cytology from hilar lymph node findings were consistent with sarcoidosis. Subsequently, based on clinical features and cytological findings, the case was diagnosed as incomplete Heerfordt’s syndrome. Key words: facial palsy, Heerfordt’s syndrome, sarcoidosis. (BIRDEM Med J 2021; 11(1): 67-69) INTRODUCTION Although it is a diagnosis of exclusion, a comprehensive Sarcoidosis is a systemic granulomatous disease of analysis is usually performed only for patients who do unknown aetiology. It usually affects the lungs but any not respond to treatment.5 Long term oral steroids have organ maybe involved.1 Heerfordt’s syndrome is been used to treat this syndrome with variable response. described as a part of spectrum of sarcoidosis occurring We herein report a case of a 50-year-old female who in approximately 0.3% of sarcoidosis cases.2 It presents presented with bilateral facial nerve palsy, was later with fever, uveitis and bilateral parotid gland swelling found to be a case of Heerfordt’s syndrome. with unilateral or bilateral facial nerve palsy.3 According to the diagnostic guidelines of sarcoidosis proposed by CASE REPORT the Japan Society of Sarcoidosis and other A 50-year-old diabetic, hypertensive lady presented with granulomatous disorder in 2006,4 Heerfordt’s syndrome the complaints of inability to close left eye for 14 days is classified into complete type, in which all four main and right eye for 11 days.
    [Show full text]
  • Simultaneous Bilateral Facial Nerve Palsy- Case Series and Review of Literature Achal Gulati, Virangna Taneja* and Ankush Sayal
    Case Report iMedPub Journals British Journal of Research 2018 http://www.imedpub.com/ Vol.5 No.1:39 ISSN 2394-3718 DOI: 10.21767/2394-3718.100039 Simultaneous Bilateral Facial Nerve Palsy- Case Series and Review of Literature Achal Gulati, Virangna Taneja* and Ankush Sayal University Hospital Coventry and Warwickshire NHS Trust, Masonway, Birmingham B152EE, United Kingdom *Corresponding author: Virangna Taneja, University Hospital Coventry and Warwickshire NHS Trust, Masonway, Birmingham B152EE, United Kingdom, Tel: 447435629610; E-mail: [email protected] Received Date: March 18, 2018; Accepted Date: March 28, 2018; Published Date: March 31, 2018 Copyright: © 2018 Gulati A, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Citation: Gulati A, Taneja V, Sayal A (2018) Simultaneous bBilateral Facial Nerve Palsy - Case Series and Review of Literature. Br J Res Vol. 5 No. 1: 39. and is usually acute in onset [3] and unilateral but in rare cases may present as bilateral palsy. Sarcoidosis, on the other hand, is Abstract a systemic, chronic, granulomatous disease that mainly affects the lungs. Bilateral facial nerve involvement known as Heerfordt Simultaneous bilateral facial paralysis is a rare condition fever due to occult Sarcoidosis is an extremely rare phenomenon comprising of 0.3-2% of cases of facial palsy and is defined and can be the presenting complaint in a wide spectrum of the as palsy affecting both sides of the face over a period no disease [6].
    [Show full text]
  • Heerfordt's Syndrome: a New Atypical Clinical Presentation
    Case Report J Anest & Inten Care Med Volume 2 Issue 1 -March 2017 Copyright © All rights are reserved by Aitel-kerdoudi M DOI: 10.19080/JAICM.2017.02.555576 Heerfordt’s Syndrome: A New Atypical Clinical Presentation Aitel-kerdoudi M*, Chafiki Z, Lakhdim M, Merzouki B, Rouadi S, Abada R, Roubal M and Mahtar M Ibn Rochd University Hospital, Morocco Submission: December 01, 2016; Published: March 27, 2017 *Corresponding author: Aitel-kerdoudi Mehdi, Hopital 20 Aout, ENT Service, CHU Ibn Rushd, Casablanca, Morocco, Email : Abstract Heerfordt’s syndrome is an unusual clinical manifestation (less than 5%) of sarcoidosis, characterized by parotitis, uveitis, and peripheral facial palsy, febrile syndrome is usually associated. Oral corticosteroid is the treatment of choice. We report a case of a patient in which the syndrome of Heerfordt was retained. Keywords: Heerfordt’s syndrome, parotitis, uveitis, sarcoidosis, facial palsy. Introduction which revealed the presence of nodular lesions in the lower The sarcoidosis is a systemic granulomatosis of unknown horn. A biopsy of the lesions was performed which results cause, characterized by its clinical polymorphism and a wide normal. The evolution of the symptomatology was marked by variety of its modes of presentation. The combination of the appearance of erythema nodosum on the face and the upper limbs (Figure 1). Heerfordt’s syndrome which presents an unusual manifestation fever, uveitis, parotitis and peripheral facial paralysis defines of this disease. We report a case of a patient in which the syndrome of Heerfordt was found. the cutaneous lesions which showed non-caseatingepithelioid The diagnosis of sarcoidosis was confirmed by the biopsy of granulomas.
    [Show full text]
  • Differential Diagnosis in Neurology and Neurosurgery
    I Differential Diagnosis in Neurology and Neurosurgery A Clinician’s Pocket Guide Sotirios A. Tsementzis, M.D., Ph.D. Professor and Chairman of Neurosurgery Director of the Neurosurgical Institute University of Ioannina Medical School Ioannina, Greece 16 Illustrations Thieme Stuttgart · New York 2000 Tsementzis, Differential Diagnosis in Neurology and Neurosurgery © 2000 Thieme All rights reserved. Usage subject to terms and conditions of license. II Library of Congress Cataloging-in-Publication Data Tsementzis, S. A. Differential diagnosis in neurosurgery / Sotirios A. Tsementzis. p. cm. Includes bibliographical references and index. ISBN 3-13-116151-5. – ISBN 0-86577-830-2 1. Nervous system–Surgery–Diagnosis Handbooks, manuals, etc. 2. Diagnosis, Differential Handbooks, manuals, etc. I. Title. [DNLM: 1. Nervous System Diseases–diagnosis. 2. Diagnosis, Differential. 3. Neurologic Examination. 4. Signs and Symptoms. WL 141 T881d 1999] RC348.T84 1999 616.8’0475–dc21 DNLM/DLC for Library of Congress 99-23138 CIP Cover drawing by Cyclus, Stuttgart Any reference to or mention of manufac- turers or specific brand names should not be Important Note: Medicine is an ever- interpreted as an endorsement or advertise- changing science undergoing continual ment for any company or product. development. Research and clinical ex- Some of the product names, patents, and reg- perience are continually expanding our istered designs referred to in this book are in knowledge, in particular our knowledge fact registered trademarks or proprietary of proper treatment and drug therapy. names even though specific reference to this Insofar as this book mentions any dosage fact is not always made in the text. Therefore, or application, readers may rest assured the appearance of a name without designa- that the authors, editors, and publishers tion as proprietary is not to be construed as a have made every effort to ensure that representation by the publisher that it is in such references are in accordance with the public domain.
    [Show full text]